EP0651663B1 - Verfahren für nadellose subkutaninjektionen - Google Patents

Verfahren für nadellose subkutaninjektionen Download PDF

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Publication number
EP0651663B1
EP0651663B1 EP93918344A EP93918344A EP0651663B1 EP 0651663 B1 EP0651663 B1 EP 0651663B1 EP 93918344 A EP93918344 A EP 93918344A EP 93918344 A EP93918344 A EP 93918344A EP 0651663 B1 EP0651663 B1 EP 0651663B1
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EP
European Patent Office
Prior art keywords
ampule
valve
pressure
poppet
reservoir
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP93918344A
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English (en)
French (fr)
Other versions
EP0651663A4 (de
EP0651663A1 (de
Inventor
Steven Fisher Peterson
Charles Neal Mckinnon, Jr.
Paul Edward Smith
Takaaki Nakagawa
Victor Leon Bartholomew
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Bioject Inc
Original Assignee
Bioject Inc
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Filing date
Publication date
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Publication of EP0651663A4 publication Critical patent/EP0651663A4/de
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm rests
    • A61M5/178—Syringes
    • A61M5/30—Syringes for injection by jet action, without needle, e.g. for use with replaceable ampoules or carpules
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm rests
    • A61M5/178—Syringes
    • A61M5/31—Details
    • A61M5/315—Pistons; Piston-rods; Guiding, blocking or restricting the movement of the rod or piston; Appliances on the rod for facilitating dosing ; Dosing mechanisms
    • A61M5/31511—Piston or piston-rod constructions, e.g. connection of piston with piston-rod
    • A61M2005/31516—Piston or piston-rod constructions, e.g. connection of piston with piston-rod reducing dead-space in the syringe barrel after delivery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/58—Means for facilitating use, e.g. by people with impaired vision
    • A61M2205/583—Means for facilitating use, e.g. by people with impaired vision by visual feedback
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm rests
    • A61M5/178—Syringes
    • A61M5/20—Automatic syringes, e.g. with automatically actuated piston rod, with automatic needle injection, filling automatically
    • A61M5/2053—Media being expelled from injector by pressurised fluid or vacuum

Definitions

  • the present invention relates to a needleless hypodermic injection method.
  • Various needleless hypodermic injection devices have been known and used in the past for performing the method according to the invention. These devices, also known as jet injectors, typically use spring or compressed gas driven plungers to accelerate an injectant to a velocity sufficient to pierce through the skin and enter the underlying tissues.
  • US-A-4722728 discloses an injector which pressurizes a fluid injectant within an ampule by driving a plunger into the ampule with sufficient force to expel the desired volume of fluid.
  • Jet injection avoids or diminishes these disadvantages.
  • the characteristics of needleless or jet injections typically vary with the pressures exerted by the injection device, the nozzle diameter of the ampule, the patient's size, age and weight, the nature of the injection site, and the viscosity of the injectant.
  • a long standing basic difficulty with jet injection has been the complex problem of determining which are the preferred injection variables. These variables include: 1) pressure profile, 2) nozzle size, 3) patient factors, i.e., age, sex and size, 4) injection site, and 5) medication viscosity.
  • the repeated failures of the prior art to adequately solve these complex variables problems has contributed to the lack of acceptance of a handheld and portable jet injector in the medical community.
  • the pressure profile is the pressure exerted on the liquid injectant, typically measured over time, from the beginning to the end of the injection.
  • the pressure profile must be selected, in combination with the nozzle size and other factors, to deliver the injectant through the skin to the desired depth, preferably with minimum pain.
  • the patient factors are also important. Gender is significant as women typically have a different adipose distribution than men. Men also typically have tougher tissue that women. The patient's age is important because infants are born with very little muscle, thick layers of adipose, and very easily penetrated skin. As infants age and become mobile the adipose is gradually replaced by muscle. At adolescence the introduction of hormones changes tissue composition. Aging through mid-life is usually associated with gradual weight gain and decrease in tissue strength.
  • Injection sites are very significant because in all patients the thickness of the skin and adipose tissue varies at different regions of the body.
  • the medical profession has established generally accepted injection sites for conventional needle syringes that are best suited for specific types of injection.
  • the subcutaneous sites typically have a thick adipose layer and are free of major nerves and vasculature.
  • Intramuscular sites typically have a thin adipose layer, a thick muscle layer, and are free of major nerves and vasculature.
  • the viscosity of the injectant must be considered as it effects characteristics of the jet injection.
  • viscosity effects have been widely misunderstood in the prior art.
  • jet injection despite its great potential advantages, remains virtually unused. Accordingly, it is an object of the invention to provide an improved method for needleless injection, so That the advantages of jet injection may be brought into use.
  • the pressure profiles of the injectant, nozzle diameter, patient and injection site parameters, as well as injectant viscosity, are selected to achieve desired injection characteristics.
  • the injectant is purposely deposited on the deep fascia in a thin sheet. This provides rapid absorption into the blood stream, without the invasiveness, injection discomfort, and occasional post injection soreness associated with injection deep into the muscle.
  • an injector or needleless injection device 20 which performs the method of the present invention has a front end 22 , a back end 24 , a top surface 26 and a bottom surface 28 .
  • a trigger 30 is slidably mounted on the injector 20 adjacent the bottom surface 28 .
  • the injector 20 includes an upper housing 42 and a shorter lower housing 44 attached to the upper housing 42 .
  • the lower housing 44 has a flat upper surface 82 which lies against a flat lower surface 84 of the upper housing 42 .
  • the upper housing 42 and lower housing 44 are attached together with four (4) pins 86 .
  • the upper housing 42 and lower housing 44 together are sized and shaped to readily fit the user's hand, with the user's palm resting over the top surface 26 and side of the injector 20 , and with the user's index finger easily positionable over the trigger 30 .
  • the top surface 26 has a step or incline 34 at approximately the center of the injector 20 .
  • the upper and lower housings may alternatively be formed as a single housing.
  • the lower housing 44 is substantially hollow and defines a lower housing space 48 .
  • the upper housing 42 defines an upper housing space 46 (Fig. 6).
  • a cartridge chamber 50 for receiving and holding a compressed gas cartridge 54 , e.g., a CO 2 cartridge.
  • a cartridge seat 52 at the forward end of the cartridge chamber 50 supports the back of the cartridge 54 .
  • a generally u-shaped plastic cartridge chamber cover 56 snaps into place on the lower housing 44 over the cartridge chamber 50 .
  • a generally cylindrical piercing housing 58 is slidably positioned behind the cartridge chamber 50 within the lower housing 44 .
  • O-rings 60 seal the piercing housing 58 against the lower housing 44 while allowing the piercing housing 58 to slide within the lower housing 44 .
  • An annulus 62 extends around the circumference of the piercing housing 58 in between the o-rings 60 .
  • a cylindrical piercing body 66 is positioned within the piercing housing 58 and sealed against the piercing housing 58 by o-rings 88 .
  • a piercing point 68 extends forward from the front surface of the piercing body 66 and is centrally aligned with the neck of the cartridge 54 .
  • a seal 64 on the front end of the piercing body 66 surrounds the piercing point 68 . The seal 64 extends sufficiently forward to seal against the neck of the cartridge 54 before the piercing point 68 penetrates into the cartridge 54 .
  • a bore 70 extends through the piercing point 68 and piercing body 66 connecting to the annulus 62 .
  • a piercing body nut 74 threads into the back end of the piercing housing 58 , to secure the piercing body 66 and seal 64 in position within and against the forward end of the piercing housing 58 .
  • a piercing housing nut 76 threads into the back of the lower housing 44 . Spanner tool openings are provided in the piercing body nut 74 and the piercing housing nut 76 for assembly purposes.
  • a threaded shaft 72 extends through and engages threads in the piercing housing nut 76 .
  • a knob 78 attached to the threaded shaft 72 has a flip handle 80 which can be flipped up perpendicular to the plane of the knob 78 to allow the knob 78 and threaded shaft 72 to be more easily tuned by hand.
  • the forward end of the Threaded shaft 72 bears against the back surface of the piercing body 66 .
  • a hole 92 extends through the upper surface 82 of the lower housing to connect the annulus 62 to a bore 96 leading into the upper housing space 46 .
  • An o-ring 94 seals the connection of the hole 92 and bore 96 .
  • a transparent window lens 98 secured to an end nut 108 by a rubber window retainer 100 .
  • a Bourdon tube 116 is soldered into a gauge base 114 and has an open end 124 extending into a gauge chamber 122 .
  • the pointer 102 extends perpendicularly from the back end of the Bourdon tube 116 .
  • a gauge label 104 applied to the back end of a gauge body 106 around the Bourdon tube 116 provides a calibrated pressure scale with the scale and pointer visible through the lens 98 . Stop pins extending from the back end of the gauge body 106 provide high and low pressure end point stops for the pointer 102 .
  • the end nut 108 has threads 110 at its forward end which engage the upper housing 42 .
  • the gauge body 106 is rotated relative to the gauge base 114 .
  • the gauge body 106 and gauge base 114 are adhered together.
  • a guiding pin 112 extends from the upper housing 42 into a keyway groove and holds the gauge body 106 in place while the end nut 108 is tightened.
  • Shims 118 are provided at the front surface at the gauge base 114 , as required, for proper stack up and positioning of components in the upper housing 42 .
  • An initiator valve housing 142 is spaced apart from the gauge base 114 by a filter retainer ring 120 .
  • a sandwiched assembly of filter disks 130 and synthetic filters 132 are contained within the back end of the housing 142 .
  • O-rings 140 seal the filter disks 130 against the retainer 140 and synthetic filter 132 .
  • O-ring 126 seals the filter retainer 140 within the upper housing 42.
  • O-ring 126 and o-ring 150 seal the gauge chamber 122 such that compressed gas provided Through the bore 96 can flow out of the gauge chamber 122 only through the filters.
  • a port 148 extends through the back wall of the initiator valve housing 142 into an initiator valve chamber 146 within the housing 142 .
  • An initiator valve 144 within the initiator valve chamber 146 controls gas flow from the port 148 through the initiator valve chamber 146 to a reservoir port 154 formed through the forward wall of the initiator valve housing 142 .
  • a regulation valve 156 includes a regulation seat 158 formed around the reservoir port 154 .
  • a dart 160 moves into and out of the regulation seat 158 .
  • the dart 160 has a threaded dart shaft 162 Threaded into the narrower tube section at the back end of a poppet body 172 .
  • a dart pin 164 extending through the tube section of the poppet body 172 and the threaded dart shaft 162 secures the adjustment of the longitudinal position of the dart 160 in relation to the regulation seat 158 .
  • a reservoir spacer 166 within the upper housing 42 extends from the forward end of the initiator valve housing 142 to a poppet housing 178 , forming a reservoir 168 around the tube section of the poppet body 172 .
  • O-rings 126 seal the reservoir spacer 166 against the upper housing 42 and seal the initiator valve housing 142 to the reservoir spacer 166 .
  • a poppet valve 170 within the poppet housing 178 has a conical plastic poppet seat 188 centered within and positioned against a forward wall of the poppet housing 178 .
  • the poppet body 172 has a sharp sealing edge 200 biased against the poppet seat 188 by a compression spring 186 held in position within the poppet housing 178 by a poppet nut 180 .
  • the sealing edge 200 and poppet seat 188 may be configured with unlike angles selected so that the inner diameter contacts first, to minimize creep effects.
  • the poppet nut 180 has a threaded forward section 184 engaged to a threaded rear section 182 of the poppet housing 178 .
  • the poppet nut 180 is tuned to adjust the compression on the spring 186 and correspondingly set the cracking pressure of the poppet valve 170 .
  • the diameter of the poppet seat 188 exposed to reservoir pressure prior to crack remains constant although the conical seat may creep, as the sealing surface, facing reservoir pressure, is parallel to the axis of poppet movement.
  • the conical seat is attached to the poppet housing 178 rather than the poppet body 172 while all hard (poppet) parts are made concentric and perpendicular.
  • all hard (poppet) parts are made concentric and perpendicular.
  • irregularities in the seat 188 or soft part will creep to conform to hard parts.
  • the hard parts are free to rotate but will still conform to the existing soft part deformation.
  • the seal 206 used with the back up ring 204 may be a low friction seal.
  • this seal is pressurized only after cracking due to the poppet body being pressurized internally before cracking, seal friction is greatly minimized.
  • the poppet body begins to move during opening before this seal is pressurized. Thus, breakway friction is not increased by gas pressure.
  • the poppet and regulation valves can act as a low pressure regulator.
  • a cannula 176 is attached to and extends back from a drive piston 212 in front of the poppet valve 170 through the poppet housing 178 and poppet seat 188 and into the back section of the poppet body 172 .
  • Poppet body supply holes 174 extend through the poppet body 172 (Fig. 3).
  • a cannula exhaust hole is provided through the cannula 176 at a position just slightly behind the o-ring 207 which slidably seals the cannula 176 .
  • radially spaced apart drive bores 194 extend through the poppet housing 178 and connect a poppet annulus 198 to the front surface of the poppet housing 178 .
  • the poppet annulus 198 a ring-shaped space, is formed by the inside walls of the poppet housing 178 , the front surface of the poppet 172 and the conical surface of the poppet seat 188 .
  • the front ends of the drive bores 194 are sealed by a preferably rubber disk drive bore seal 196 adhered to the back surface of the drive piston 212 .
  • a joggle 192 in the poppet housing 178 which engages a corresponding lip within the upper housing 42 , acts as a stop for the poppet housing 178 .
  • the reservoir spacer 166 , initiator valve housing 142 , filter ring, shims and the gauge body 106 are then subsequently installed within the upper housing 42 and stack up against the poppet housing 178 , with the end nut 108 clamping these components in place.
  • o-rings 206 slidably seal the poppet body 172 against the poppet housing 178 and poppet nut 180 .
  • the o-rings 206 and back up rings 204 prevent metal to metal contact during movement of the poppet body 172 and also act as pivots and guides to allow slight eccentricity between the poppet body 172 and poppet nut 180 .
  • a ring-shaped plenum 202 is formed between the poppet housing 178 and the drive piston 212 , or the o-ring 214 which slidably seals the drive piston 212 Within the upper housing 42 .
  • the plenum 202 is just wide enough to insure compression on the face seal 195 .
  • a backup ring 218 is provided adjacent to the drive piston seal 214 which is preferably a low friction U-seal.
  • a clap piston 210 is slidably positioned within the drive piston 212 and slidably seals against the drive piston 212 with a clamp piston o-ring 222 .
  • the back surface of the clamp piston 210 and the front vertical wall of the drive piston 212 form a clamp piston plenum 216 (Fig. 3).
  • An o-ring joggle 220 adjacent the back end of the drive piston 212 acts as a stop for the clamp piston o-ring 222 .
  • a clap piston spring 224 within the clamp piston 210 biases forward a jaw plate 228 butting against two opposing flange walls 229 (shown in phantom in Fig. 4) extending from a jaw retainer nut 242 , allowing just enough clearance for the jaws to move freely.
  • the force of the clamp piston spring 224 is accordingly transferred from the plate 228 to the flange walls 229 to the jaw retainer nut 242 and bypasses the clamp jaws 236 .
  • the clamp jaws 236 are biased outwardly or apart and away from each other by a pair of spaced apart jaw springs 238 .
  • the clamp jaws 236 have fine teeth 240 .
  • Each clamp jaw 236 has a planar ramp surface 234 flatly engaged by a corresponding planar ramp drive surface 232 on the forward end of the clamp piston 210 .
  • the jaw retainer nut 242 is threaded into the front end of the drive piston 212 .
  • a return spring 244 is compressed in between the jaw retainer nut 242 and a pressure plate 248 .
  • An indicator ring 250 is rotatably positioned in between the front end of the upper housing 42 and a front collar 252 threaded onto the front end of the upper housing 42 .
  • the indicator ring 250 has colored sections on its outside edge visible through view ports 256 in the front collar 252 , when the indicator ring 250 is turned to a ready to actuate position signifying that the ampule lugs are fully engaged with the injector lugs,
  • a detent pin 288 biased against the back surface of the indicator ring 250 holds the indicator ring in either the ampule loading/unloading position or the ready position, and provides a positive tactile (and optionally an audible click) indication that the ampule is correctly and fully installed, Referring to Fig. 13a, the detent pin 288 slides in or slides against a track 324 cut into the back of the indicator ring.
  • the return spring 244 biases the pressure plate 248 forward, to clamp an ampule behind the lugs 254 on the front collar 252 , and it also acts to return the drive piston after an injection.
  • the indicator ring 250 has three equally spaced apart tuning lugs 258 extending inwardly, for engaging the lugs 382 at the back of an ampule 360 (Fig. 10).
  • the front collar 252 has three equally spaced apart retaining lugs 254 extending radially inwardly, for engaging the front surfaces of the ampule lugs 382 , to hold the ampule into the injector 20 .
  • an actuator link 262 has a forward hook 264 in front of the indicator ring 250 .
  • a rear hook 260 on the actuator link 262 is attached to an actuator slide block 266 slidably mounted in between the upper housing 42 and lower housing 44 .
  • a slide block spring 268 pushing off of the lower housing 44 forwardly biases the actuator slide block 266 .
  • the forward surface of the actuator slide block 266 forms the trigger 30 .
  • an exhaust valve fork 270 extends laterally and upwardly from the actuator slide block 266 to engage a collar on a spool valve 286 .
  • the slide block 266 has a rounded back end 272 facing an initiator valve cam 274 pivotally attached to a holder with a roll pivot pin 278 . Together they are held in a cavity in the upper housing by the upper surface of the lower housing.
  • a gap 280 separates the rounded slide block end 272 and the initiator valve cam 274 (Fig. 3).
  • a set screw 276 threaded into the initiator valve cam 274 engages an initiator pin in the initiator valve 144 .
  • an orifice 282 in the upper housing 42 connects to a drive plenum exhaust bore 284 to continuously vent or bleed the drive plenum 202 to ambient pressure.
  • the orifice has an approximately 0.10 mm diameter opening.
  • the spool valve 286 attached to the exhaust valve fork 270 is slidably positioned within a spool housing 294 secured within an exhaust passage 296 in the upper housing 42 .
  • the spool valve 286 fits within a spool bore 302 in the spool housing 294 with a very close tolerance. While the spool valve 286 does not absolutely seal against the spool bore 302 , leakage between them is very low.
  • a reservoir exhaust bore 290 links the reservoir 168 to a spool valve plenum 300 around the spool valve 286 .
  • a spool valve hole 301 leads from the spool valve plenum 300 to an exhaust duct 304 behind the spool valve 286 .
  • O-rings 292 are positioned on either side of the spool valve plenum 300 to seal the stationary spool valve housing 294 around the reservoir exhaust bore 290 .
  • Muffler seals 306 seal the forward end of the spool valve housing 294 against a muffler tube 308 filled with fiberglass wool 310 or other acoustic material and leading to an exhaust port 316 open to ambient pressure.
  • a muffler retainer 312 and set screw 314 secure the spool valve housing 294 , muffler seals 306 and muffler tube 308 within the exhaust passage 296 .
  • the initiator valve 144 has an initiator valve pin 330 extending from a pin socket 332 .
  • a socket spring 334 overlying the pin socket 332 biases the initiator valve pin 330 outwardly or downwardly into engagement with the set screw 276 in the initiator valve cam 274 .
  • a valve stem 336 spaced slightly apart from the pin socket 332 has a stem collar 342 with a rubber seat ring 340 sealably engaging a seat neck 350 , within an upper chamber 344 of the initiator valve 144 .
  • a stem collar spring 346 positioned in between a valve nut 348 and the stem collar 342 biases the seat ring 340 into engagement with the seat nut 350 to maintain the valve 144 in a closed position.
  • the seat nut 350 is supported by, or part of a valve seat 352 sealed within the initiator valve chamber 146 by an o-ring 338 .
  • the housing is a single piece housing 303 , rather than the two-piece housing shown in Fig. 2.
  • FIG. 6b An alternative preferred design to the exhaust valve shown in Fig. 6 is illustrated in Fig. 6b wherein a valve stem 291 slides inside of a front seal 293 and a rear seal 295 .
  • a seal spacer 297 separates the front seal 293 and the rear seal 295 .
  • the rear end of the valve stem 291 has two narrow slots 305 which provide a channel for flow of gas when the valve is opened, while giving support to the pressurized rear seal 295 to prevent it from collapsing inwardly,
  • the slots 305 form a gradual angle with the rear seal 295 to prevent it from catching on an abrupt edge which could damage the seal.
  • valve stem 291 When actuated, the valve stem 291 is pushed forward and the front edge of the valve slots 305 moves forward to the forward edge of the rear seal 295 .
  • This allows pressurized exhaust gas to flow from an inlet port 307 , through the seal spacer 297 , out of the valve slots 305 , through a muffler 309 and into an outlet port 311 .
  • the front and rear seals 293 and 295 are both u-cup type seals to provide for low friction.
  • the exhaust valve is virtually gas tight and requires very little force for actuation. The only significant force that is translated to the valve stem is after opening, the stem is forced to open further which assists in returning the actuator of the injector.
  • Fig. 6c shows a piston plenum shut-off valve 321 used in the housing 303 , as an alternative to the continuously venting orifice 282 and drive plenum exhaust bore 284 shown in Fig. 6.
  • Shut-off valve 321 includes a piston 323 which has a filter 325 , an orifice 327 and a seal 329 .
  • the piston 323 is biased upwardly and into an open position via a spring 331 .
  • the force keeping the piston 323 down against the seal is provided by the pressure acting on the area of the annulus created by the piston seal 329 and the shut-off seal 333 .
  • the shut-off seal 333 is supported by a valve base 335 which has a vent 337 beneath the shut-off seal 333 to prevent seal escape. Passageways 339 are provided for venting gas.
  • the pressure acting on the valve is reduced, the piston 323 moves away from the shut-off seal 333 due to force provided by a spring 331 , and gas flows freely through the filter 325 , the orifice 327 , and through the passages 339 in the valve base 335 .
  • Figs. 7a and 7b show an alternate preferred embodiment initiator valve 145 (illustrated in the closed position).
  • the initiator valve 145 includes an initiator valve body 147 having an inlet 149 and an outlet 151 .
  • a valve poppet 153 is biased against a valve seat 155 by a spring 157 .
  • the valve seat 155 is preferably ethylene-propylene which resists absorption by carbon dioxide.
  • a valve seat retainer 159 supports the valve seat 155 .
  • a valve stem 169 passes through a valve stem guide 161 and a valve stem seal 163 .
  • a valve stem spring 165 biases the valve stem into a closed position.
  • a valve stem seal 167 slidably seals the valve stem against the valve stem guide 161 .
  • an ampule 360 has three spaced apart lugs 382 at its back end.
  • a flare 380 leads into an ampule chamber 384 to guide a contoured end 364 of a plunger 362 to engage the ampule 360 .
  • the plunger shaft 372 has a cruciform cross section to provide a high moment of inertia using minimum material for the disposable plunger and ampule.
  • a collar 374 on the plunger 362 is spaced apart from the tip of the contoured end 364 so that the collar 374 contacts the back surface 388 of the ampule 360 just before the contoured end 364 of the plunger 362 reaches the front end of the ampule 360 . This prevents the contoured end 364 from colliding with the front end of the ampule 360 and overstressing the ampule or buckling the plunger shaft 372 .
  • Webs 376 extending from the plunger shaft 372 support the collar 374 .
  • the back section 390 of the plunger shaft 372 may have teeth or ridges 378 matching the teeth or ridges 240 on the inside surfaces of the clap jaws 236 , a smooth back section 390 is preferred to avoid variations.
  • the cartridge 54 is loaded into the injector 20 by removing or unsnapping the plastic cartridge chamber cover 56 , placing the cartridge 54 into the cartridge chamber 50 , with the neck of the cartridge 54 facing the piercing point 68 , and then replacing the cartridge chamber cover 56 .
  • the cartridge chamber cover 56 snaps into position on the lower housing 44 .
  • a wavy brass liner 32 say be provided in the cartridge chamber 50 to increase thermal conductivity between the cartridge 54 and the injector 20 .
  • the flip handle 80 on the knob 78 is flipped outwardly so that the knob 78 can be more easily tuned.
  • the knob 78 is turned by hand causing the threaded shaft 72 to advance forwardly and drive the piercing body 66 and housing 58 towards the cartridge 54 .
  • the seal 64 engages and seals against a perimeter on the flat end surface of the cartridge 54 .
  • the piercing point 68 engages and pierces the cartridge seal. Compressed gas from the cartridge 54 flows through the bore 70 , into the annulus 62 , through the hole 92 and moves through the bore 96 into the gauge chamber 122 .
  • the seal 64 prevents leakage of compressed gas into the cartridge chamber 50 which remains at ambient pressure.
  • the cartridge seat 52 supports the cartridge 54 longitudinally against the force exerted by the seal 64 and piercing pin 68 .
  • O-rings 60 , 88 and 94 prevent leakage from the passageways from the cartridge 54 to the gauge chamber 122 .
  • the knob 78 moves forward towards the piercing housing nut 76 .
  • the piercing body 66 and housing are in a fully forward position and the back surface of the knob 78 is approximately flush with the back surface of the upper housing 42 .
  • Compressed gas fills the gauge chamber 122 , passes through the filters 130 and 132 , flows through the port 148 (Fig. 3) and into the upper chamber 344 of the initiator valve 144 (Fig. 7).
  • the stem collar spring 346 biases the seat ring 340 on the stem collar 342 against the seat neck 350 , thereby sealing the upper chamber 344 and preventing the compressed gas from moving forward.
  • the cartridge 54 contains a saturated propellant gas, such as CO 2 , in both liquid and gas states, at temperatures near room temperature.
  • a saturated propellant gas such as CO 2
  • the filters 130 and 132 substantially prevent any liquid from the cartridge 54 from passing. This allows the device to be used in any orientation without affecting injection characteristics. Without the filters, liquid CO 2 could pass into the initiator valve 144 and reservoir 168 and flash into gas during actuation of the injector 20 , causing unpredictable injection characteristics.
  • the Bourdon tube 116 which opens into the gauge chamber 122 is also pressurized, The pressure within the Bourdon tube 116 causes it to spiral outwardly resulting in movement of the pointer 102 to indicate the gas pressure on the gauge label 104 (after the gauge body 106 and gauge base 114 have been properly calibrated), The user can then check the available gas pressure within the injector 20 by looking at the pointer 102 through the lens 98 , as shown in Fig. 8.
  • the ampule 360 , plunger 362 and a filling needle may be provided in a sterile package.
  • the filling needle has a fitting to engage the Luer fitting 392 on the ampule.
  • the ampule may be filled in the same way as a conventional needle and syringe, The filling needle is inserted into a vial of injectant and the injectant is drawn up into the ampule by pulling back on the plunger. Dosage is read by the alignment of the red o-ring 366 with volume graduations on the transparent ampule. The filling needle is removed and safely discarded.
  • the ampule is then ready to be placed into the injector, Variable dosage injections are accordingly achieved by loading the ampule in the same manner as for a needle and syringe,
  • the present injector 20 can inject various dosages without adjusting the injector.
  • the ampule 360 may be filled to e.g., 1/3, 1/2, 3/4, etc. of its full volume capacity, Referring to Fig. 10, loading the ampule 360 with differing volumes of injectant will cause the plunger 362 to extend from the ampule 360 by varying amounts.
  • the injector 20 can successfully drive the plunger 362 from any plunger starting position, a single size ampule 360 can be used for various dosage injections. Ampules of varying volumes are not required.
  • the plunger and ampule are installed into the injector 20 .
  • the lugs 382 on the ampule 360 are aligned to pass through the lugs 254 on the front collar 252 .
  • the back end of the plunger 362 is passed Through the front collar 252 , through the return spring 44 and through the clamp piston spring 224 . Since the teeth or ridges 378 on the plunger 362 extend continuously in between the webs 376 and the back end of the plunger, regardless of the dosage carried by the ampule 360 , the teeth 240 of the clamp jaws 236 will over lie the plunger 362 .
  • the back surface 388 of the ampule 360 comes to rest against the pressure plate 248 .
  • the lugs 382 on the ampule 360 fit in between the lugs 258 on the indicator ring 250 .
  • the user then turns the ampule (clockwise as viewed from the front) through an acute angle e.g., approximately 45°, from an ampule loading position to an ampule ready position.
  • the ampule causes the indicator ring 250 to turn with it as the sides of the ampule lugs 382 push against the sides of the indicator ring lugs 258 .
  • a step on each ampule lug prevents the indicator ring and ampule from being turned beyond range.
  • the track on which the detent pin 288 acts is deep enough that the detent cannot be forced out of the track.
  • the two ends of the track act as detent stops.
  • the indicator ring 250 turns and locks into an injection ready position (Fig. 2a)
  • the colored or painted sections on the outside perimeter of the indicator ring 250 moves into view through the view ports 256 . This indicates to the user that the ampule is properly installed in the injector 20 and ready for injection.
  • a cut out 320 in the indicator ring moves into alignment with the hook 264 on the actuator link 262 .
  • the trigger 30 can then be pulled back to actuate the injector 20 to provide an injection to a patient.
  • the actuator link 262 prevents the trigger 30 from moving to actuate the device. Therefore, the injector 20 cannot be actuated unless an ampule is properly installed and aligned in the ready position.
  • the nozzle 386 of the ampule 360 is placed against the patient's skin and the trigger 30 on the actuator slide block 266 is pulled back by the user's index finger.
  • the exhaust valve fork 270 slides the spool valve 286 from an open position (which allows the reservoir 168 to bleed or exhaust through the exhaust bore to ambient) to a closed position wherein the spool valve 286 substantially seals off the reservoir exhaust bore 290 .
  • the reservoir 168 is accordingly sealed off before the slide block end 272 engages the initiator valve cam 274 .
  • the spool valve serves as an exhaust control valve.
  • the slide block end 272 pushes against the initiator valve cam 274 levering the set screw 276 against the initiator valve pin 330 .
  • the sliding movement of the trigger performs three functions: It controls the initiator valve, it controls the spool valve, and it provides an interlock when disabled by the actuator link 262 .
  • the set screw 276 pushes up on the initiator valve pin 330 .
  • the pin socket 332 is driven up against the valve stem 336 causing the stem collar to shift upwardly and separate the seat ring 340 from the seat neck 350 , thereby opening the initiator valve 144 .
  • the valve poppet spring 157 biases the valve poppet 153 toward the valve seat 155 . Gas pressure from the gas inlet 149 drives the poppet 153 into the valve seat 155 creating a gas tight meal.
  • the valve seat 155 is vented on the bottom side 171 to prevent the seat from escaping from the groove 173 .
  • the valve seat retainer 159 retains and vents the valve seal 155 .
  • the valve stem 169 is mechanically isolated from the poppet 153 to assure that the poppet closes without interference from the stem.
  • valve stem 169 slides up and contacts the valve poppet 153 , pushing it away from the valve seat 155 .
  • valve stem spring 165 returns the valve stem to the neutral position and the valve poppet 153 also returns to the closed position.
  • compressed gas flows from the cartridge 54 through the filters and initiator valve 144 , through the reservoir port 154 past the dart 160 and into the reservoir 168 .
  • gas pressure also builds within the poppet chamber 208 , as gas flows from the reservoir 168 through the poppet body supply holes 174 .
  • the clamp piston 210 is driven forward compressing the clamp piston spring 224 and driving the clamp jaws 236 together, through the interaction of the ramp drive 232 on the clamp piston 210 and the clamp piston ramps 234 on the clamp jaws 236 .
  • the teeth 240 on the clamp jaws 236 clamp down and around the plunger 362 .
  • the clamp jaws 236 and their driving mechanism perform two functions: They grab onto the plunger at whatever position the plunger is in, and they transfer driving force from the drive piston to the plunger.
  • the plunger 362 will be fully extended to the rear such that the clamp jaws 236 will engage the plunger 362 close behind the webs 376 .
  • the plunger 362 will extend a shorter distance behind the ampule 360 and the clamp jaws 236 will engage the plunger 362 towards the back end of the plunger.
  • the clamp jaws 236 securely clamp and engage the plunger 362 with the teeth 240 on the clamp jaws 236 locked into the teeth 378 on the plunger 362 .
  • the gas pressure in the clamp piston plenum 216 maintains the engagement of the clamp jaws 236 to the plunger 362 during the injection sequence. As represented in Fig. 12, the clap jaws clap onto the plunger before the poppet valve opens.
  • pressure in the poppet chamber 208 continues to build until it is sufficient to crack the poppet valve 170 open.
  • the poppet spring chamber 226 is sealed from the reservoir 168 and the poppet chamber 208 and is vented to ambient pressure.
  • the rearward acting force resulting from the gas pressure acting on the incline surfaces 152 of the poppet body 172 will exceed the forward acting force of the poppet spring 186 .
  • this "cracking point" is reached, the poppet valve 170 snaps open.
  • the poppet body 172 shifts or slides rearwardly,
  • the sealing edge surface 200 separates from its sealing engagement against the conical poppet seat 188 allowing gas from the reservoir 168 to flow through the poppet chamber 208 to the drive bores 194 .
  • the poppet valve 170 begins to open and the poppet body 172 moves away from the conical poppet seal 188 , the annular front surface 230 of the poppet body 172 is acted on by gas pressure now in the poppet annulus 198 . Since the surface areas acted on by the compressed gas are vastly increased with the addition of the front surface 230 of the poppet body, the force acting on the poppet body 172 rapidly escalates.
  • the poppet valve 170 therefore opens with an "over-center" or hard-over action.
  • the regulation valve 156 closes down via the dart 160 engaging and sealing against the regulation seat 158 .
  • additional gas supply to the reservoir 168 is, at least initially, restricted by the regulation valve 156 , with substantially only the reservoir 168 then acting as a source of compressed gas.
  • pressure regulation of the reservoir is provided through poppet area ratios and spring forces (which may be readily determined for various capacity injectors by those skilled in the art).
  • the reservoir pressure reaches a desired minimum pressure.
  • the drive piston plenum has been supplied by a fixed supply of gas from the reservoir.
  • the spring force acting forwardly on the poppet body, overcomes the net pressure force, acting rearwardly on the poppet body.
  • the poppet body moves forward, lessening the regulation valve restriction to incoming flow.
  • the dart 160 moves with the poppet body away from the seat 158 to allow commencement or increase of gas flow.
  • the opening of the regulator valve consequently increases gas flow into the reservoir and increases the reservoir pressure.
  • the poppet body again moves rearwardly to restrict the incoming flow,
  • the poppet valve and regulator valve act together as a reservoir pressure regulator (and consequently drive piston plenum pressure and ampule pressure).
  • regulation movement when present, occurs generally during the last half of the injection.
  • the CO 2 cartridge is filled with saturated CO 2 .
  • the peak ampule pressure is determined by the poppet valve cracking pressure which is independent of source pressure.
  • the minimum delivery pressure, governed by the pressure regulation is also independent of source pressure. Both of these features are controlled by area ratios and spring rates.
  • the injector is substantially temperature independent.
  • Fig. 12 illustrates the effect of pressure regulation.
  • a smaller dosage of e.g., 1/2 ml or less generally there is no pressure regulation.
  • larger dosages of e.g., over 3/4 ml pressure regulation occurs.
  • intermediate range dosages of e.g., between 1/2 and 3/4 ml some pressure regulation may occur.
  • the rubber or elastomeric face seal 196 adhered to the back of the drive piston 212 assists to rapidly open the poppet valve 170 .
  • the face seal 196 encourages the build up of pressure in the drive bores 194 and poppet annulus 198 before pressurizing the drive plenum 202 . Accordingly, the rapid pressure increase within the drive bores 194 and poppet annulus 198 shorten the time required for opening the poppet valve 170 providing a quick ampule pressure rise time and a more uniform ampule peak pressure.
  • the poppet body supply holes 174 have a large diameter to minimize pressure drop from the reservoir 168 to the poppet chamber 208 .
  • the trigger 30 is held back for longer than necessary for the injection, only a small amount of gas is wasted since all spaces within the injector, except the drive plenum, remain virtually sealed while the trigger is held back.
  • the drive plenum is opened to ambient pressure, but only through orifice 282 which severely restricts flow.
  • the regulation valve 156 restricts flow while the trigger is held back.
  • the trigger is released.
  • the slide block spring 268 assisted by exhaust gas pressure returns the slide block 266 to its forward position.
  • the initiator valve then closes, Then the exhaust valve fork 270 moving with the slide block 266 pulls the spool valve 286 forward reconnecting the spool valve bore 302 and spool plenum 300 to the reservoir exhaust bore 290 .
  • the spool valve and exhaust passage allow the injector to be quickly and quietly reset for another injection, Gas in the reservoir exhausts out through the reservoir exhaust bore 290 and exhaust passage 296 .
  • the exhaust gas pressure in the exhaust passage 296 pushes on the back of the spool valve 286 and helps to return the spool valve and slide block forward to their original ready positions.
  • the slide block spring 268 consequently need only exert a slight force, thereby helping to reduce the finger force necessary to pull the trigger 30 .
  • the drive piston 212 is in the forward position (Fig. 2c), with the plunger shoulder in contact with and exerting a large force on the back end 388 of the ampule 360 .
  • the drive piston return spring 244 , clamp piston spring 224 and jaw springs 238 are compressed.
  • the jaws 236 are engaged with the plunger and the clamp piston 210 is forward. Each part must then return to the ready position.
  • the reservoir 168 Upon release of the trigger 30 , the reservoir 168 is able to rapidly vent to atmosphere.
  • Drive piston plenum gas vents into the reservoir, in part, through the poppet body, until the poppet valve closes, Gas also vents into the reservoir through the cannula 176 , until the holes in the cannula are sealed by the o-ring 190 contained within the poppet seat 188 .
  • This remaining gas which occupies a relatively small volume, and is at a very low pressure, vents through the bleed orifice 282 connecting the drive piston plenum directly to the atmosphere through the drive plenum exhaust bore 284 . Since the orifice 282 is always open, even during the injection, some beneficial drive gas is lost, thus it is a very small, restrictive orifice. Because the orifice 282 is small, if it was the only vent for drive piston plenum gas (i.e., if there were no cannula side holes), venting and reset time would be unacceptably long.
  • the following reset sequence occurs and is controlled by component areas and spring forces, which may be readily determined by those skilled in the art.
  • the clap jaws 236 and clap piston 210 release. This must occur before the drive piston is released so that the plunger is not pulled back.
  • the clamp piston spring force overcomes the opposing pressure force. This release occurs when the drive piston 212 is close to a force equilibrium condition. The pressure force must be close to the opposing spring force. If not, then the drive piston 212 will rapidly return (if the spring force is larger) or plunge forward (if pressure force is larger) causing noise and possible damage to the injector, Thus a force balance is established at the point of plunger release, regardless of the dosage.
  • the drive piston 212 After the plunger release, the drive piston 212 returns as the reservoir bleeds. The drive piston 212 is forced rearward by the drive piston return spring against the opposing pressure force. Gas exhaust and reset occurs quietly and quickly.
  • O-ring 222 serves as a seal and a bumper to quiet the clamp piston return.
  • the plunger 362 is driven forward until the collar 374 contacts the back surface 388 of the ampule 360 . Accordingly, if the trigger 30 is squeezed once and an injection given, released and squeezed again after some delay (i.e., "second fire") without replacing the ampule, the jaws will grab the plunger with the plunger collar in the forward most position, i.e., in contact with the rear ampule face. Thus no forward movement of the drive piston will occur. A second fire does not damage the ampule, plunger or injector.
  • the cannula 176 is attached to and moves with the drive piston 212 .
  • the cannula exhaust hole 190 in the cannula 176 speeds the return stroke of the piston 212 .
  • the poppet valve closes before the drive piston begins its return, Thus a bleed hole in the cannula is required for gas to flow from the drive piston plenum to the reservoir.
  • gas in the drive plenum 202 flows through the cannula exhaust hole 190 through the cannula 176 , back into the reservoir 168 and out through the relatively unobstructed exhaust system of the reservoir exhaust bore 290 and the exhaust passage 296 .
  • the spent ampule and plunger are turned and removed from the injector 20 which is then prepared for the next injection sequence.
  • the ampule and plunger are preferably a single use disposable unit.
  • the plunger may have tapered sections at the front or back which engage a generally complimentary tapered section in the ampule.
  • the injector exerts hundreds of pounds of force on the plunger which drives the tapered section of the plunger of Figs. 10a and 10b into an interference fit with the tapered section of the ampule.
  • the used and non sterile plunger and ampule cannot easily then be re-used.
  • the tapered sections can also act as a plunger stop, in place of the collar on the plunger of Fig. 10, The taper on the plunger and ampule are slightly mismatched and lock together only with high forces (at the end of an injection) and not at low forces (during filling of the ampule).
  • Fig. 10c shows another non-reusable ampule and plunger having a detent. The detent is dimensioned so that only a large force will cause engagement.
  • the injector can be modified to give multiple sequential injections to the same patient.
  • a drive piston stop 394 is added, and acts to stop the drive piston, as the plunger shoulder does in variable delivery.
  • the jaws then disengage and the injector resets.
  • the plunger will automatically be in a "ready” position for the next shot, and the injector may be fired again to deliver the same small dosage.
  • This sequence may be repeated to deliver several small dosage injections until the plunger shoulder contacts the ampule. Dosage may be adjusted by rotating the outer ring 396 to the desired value, indicated by graduations 398 on the injector housing. A longer ampule can be provided to allow for more sequential shots.
  • the present method of needleless injection uses a system of an injector and compatible ampules.
  • the injector is designed to apply a specific force on the plunger of the ampules.
  • the force applied to the plunger by the injector is varied, forming a force - displacement curve.
  • the force applied to the plunger is quite high.
  • the applied force is reduced substantially linearly until the volume injected reaches approximately 0.5 ml, and thereafter the force is held substantially constant.
  • This force displacement curve is independent of the ampule nozzle size.
  • This force - displacement curve translates directly to an ampule pressure - volume injected curve.
  • the injection system employs a singular pressure profile and a family of ampules with various orifice sizes to achieve various depths of penetration.
  • Fig. 17 shows preferred uses of various diameter nozzles with the pressure profile described below.
  • the preferred pressure profile has the following properties: First the pressure rapidly increases from 0 to a value of about 26900-29670 kPa, and preferably about 28290 kPa, (4100 psi) in less than 6 milliseconds (and preferably less than 1 ms). This quick pressure rise avoids "splash-back" and loss of injectant. This pressure range is sufficient to pierce the tissues, but not so high as to cause the excessive pain associated with higher pressures. The pressure is gradually reduced to approximately 8280 - 13800 kPa, and preferably 12420 kPa, (1800 psi) in a generally linear (pressure - volume) fashion corresponding with volume discharged of 0.5 ml.
  • the curve forms an exponential decay.
  • the pressure is held constant until the end of the injection, at which time the pressure abruptly goes to 0 within 5 ms.
  • Final pressures below about 8280 kPa tend to result in "leak-back" of the injectant after the injection,
  • the pressure profile is defined as the pressure immediately proximal to the nozzle.
  • the above- described pressure profile covers an injection larger than approximately 0.5 ml. If the injection is less than this amount, the pressure - profile curve is simply truncated at the end of the delivered volume.
  • Medication viscosity affects penetration of intramuscular injections in a direction contrary to prior art.
  • Experimental data shows that more viscous medications, in the range of from 0.01 to 0.70 poise, have greater fascia penetrating capability, apparently because of reduced turbulence and lower Reynold's number.
  • the present invention also includes the appropriate guidelines for selection of nozzle size with viscous medications.
  • Viscous medications preferably use the same size orifice as for water based medications. Nearly all viscous medications are intramuscular injections, Testing shows that viscous medications have more energy to penetrate the deep fascia than water based medications, but do not go substantially deeper into the muscle. Therefore, the deposition into the muscle is comparable independent of medication viscosity.
  • the present peri-fascial injection is provided by using a nozzle diameter which is smaller than that which would ordinarily be used for an intramuscular injection.
  • the peri-fascial injection is provided by using a SC nozzle (0.10 mm) at an IM injection site preferably with less than 5 mm adipose. This works well because IM sites tend to have very thin layers of adipose tissue.
  • the SC nozzle has sufficient penetrating energy to deposit the medication on the deep fascia when injected into a thin layer of adipose.
  • a peri-fascial injection can also be given at an IM injection site having a 10-15 mm adipose layer using a 0.15 mm diameter nozzle and the above-described pressure profile.
  • the injectant 800 in a peri-fascial injection bores through the skin 802 and adipose 804 , but not the fascia 806 . Rather, the injectant forms a thin layer 808 over the fascia, The thin layer 808 may provide the same pharmacological effect as an IM injection, without penetrating the muscle.

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  • Health & Medical Sciences (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)

Claims (5)

  1. Verfahren zum Liefern eines Einspritzstrahls durch unter Druck setzen eines fluiden Injektats innerhalb einer Ampulle (360), welches Verfahren die Schritte aufweist:
    einen Tauchkolben (362) mit ausreichender Kraft in eine Ampulle (360) treiben, so daß innerhalb von 6 Millisekunden ein Druck von 26000-30000 kPa erzeugt wird;
    den Druck im allgemeinen linear reduzieren, bis 0,5 ml herausgetrieben werden und der Druck 8000-14000 kPa beträgt;
    den Druck so lange bei 8000-14000 kPa halten, bis ein gewünschtes Volumen an Injektat aus der Ampulle (360) herausgetrieben worden ist; und
    den Druck innerhalb von 5.0 Millisekunden auf ungefähr 0.0 kPa reduzieren.
  2. Verfahren gemäß Anspruch 1, welches weiter den Schritt des Regulierens des Durchmessers der Mündungsöffnung der Ampulle (360) aufweist.
  3. Verfahren gemäß Anspruch 1 oder 2, welches weiter den Schritt des Regulierens der Viskosität des Injektats aufweist.
  4. Verfahren gemäß Anspruch 3, wobei die Viskosität des Injektats im Bereich von 0,01 bis 0,70 Poise liegt.
  5. Verfahren gemäß einem der Ansprüche 1-4, welches weiter den Schritt des Filterns des komprimierten Gases, bevor es in ein Reservoir abgelassen wird, aufweist.
EP93918344A 1992-07-24 1993-07-23 Verfahren für nadellose subkutaninjektionen Expired - Lifetime EP0651663B1 (de)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US07/920,106 US5383851A (en) 1992-07-24 1992-07-24 Needleless hypodermic injection device
US920106 1992-07-24
PCT/US1993/006940 WO1994002188A1 (en) 1992-07-24 1993-07-23 Needleless hypodermic injection methods and device

Publications (3)

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EP0651663A1 EP0651663A1 (de) 1995-05-10
EP0651663A4 EP0651663A4 (de) 1995-08-30
EP0651663B1 true EP0651663B1 (de) 1999-12-01

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EP (1) EP0651663B1 (de)
JP (2) JP3633615B2 (de)
AT (1) ATE187083T1 (de)
AU (1) AU676490B2 (de)
CA (1) CA2140772C (de)
DE (1) DE69327165T2 (de)
WO (1) WO1994002188A1 (de)

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AU4782793A (en) 1994-02-14
WO1994002188A1 (en) 1994-02-03
JP3633615B2 (ja) 2005-03-30
CA2140772A1 (en) 1994-02-03
US5399163A (en) 1995-03-21
EP0651663A4 (de) 1995-08-30
US5383851A (en) 1995-01-24
ATE187083T1 (de) 1999-12-15
JPH07509161A (ja) 1995-10-12
US5520639A (en) 1996-05-28
DE69327165D1 (de) 2000-01-05
CA2140772C (en) 2006-07-11
EP0651663A1 (de) 1995-05-10
JP2004141667A (ja) 2004-05-20
AU676490B2 (en) 1997-03-13

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